神经电生理监测技术对微创经椎间孔入路腰椎体间融合术中神经功能保护的效果分析

Effectiveness of neurophysiological monitoring technology in protecting neurological function during MIS-TLIF surgery

摘要:

目的 探究神经电生理监测技术（NEPM）对微创经椎间孔入路腰椎体间融合术（MIS-TLIF）中神经功能保护的效果。方法 前瞻性选取2021年7月—2023年7月贵州中医院大学第二附属医院80例患者，并随机分为对照组和实验组，每组40例。对照组采用常规全身麻醉，做好术后并发症护理及随访，实验组在对照组基础上实施NEPM。所有手术由同一团队执行，术中监测包括运动诱发电位（MEP）和感觉诱发电位（SEP）、肌电图。比较两组患者围手术期指标、术前术后JOA评分、腰椎前凸角度和冠状面Cobb角差值，以及MEP、SEP和肌电图监测结果。结果 两组患者围手术期指标比较，差异均无统计学意义（P >0.05）。实验组手术前后JOA评分、腰椎前凸角度和冠状面Cobb角的差值均高于对照组（P <0.05）。实验组手术前后胫后神经SEP波幅的差值高于对照组（P <0.05）。实验组手术前后平均功率频率、肌电图的差值均高于对照组（P <0.05）。结论 NEPM能有效减少MIS-TLIF术后神经功能损伤的风险。建议在类似手术中广泛应用以提高神经保护效果。

Abstract:

Objective To investigate the effectiveness of neurophysiological monitoring in protecting neurological function during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.Methods We prospectively enrolled 80 patients from the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between July 2021 and July 2023, and randomly divided them into the control group and the experimental group, with 40 cases in each group. The patients in the control group underwent standard general anesthesia with routine postoperative care and follow-up, while those in the experimental group received neurophysiological monitoring in addition to the standard protocol. All surgeries were performed by the same team, with intraoperative monitoring including motor evoked potential (MEP), somatosensory evoked potential (SEP), and electromyography (EMG). Perioperative indicators, and differences in JOA scores, lumbar lordosis angle, Cobb angle in the coronal plane, MEP, SEP, and EMG before and after the surgery were compared between the two groups.Results There was no difference in the perioperative indicators between the two groups (P > 0.05). The differences in JOA scores, lumbar lordosis angle, and Cobb angle in the coronal plane before and after the surgery were greater in the experimental group than in the control group (P < 0.05). The differences in the SEP amplitude of the posterior tibial nerve before and after the surgery were higher in the experimental group than those in the control group (P < 0.05). Additionally, the differences in mean power frequency and EMG parameters before and after the surgery were also greater in the experimental group compared with the control group (P < 0.05).Conclusions Neurophysiological monitoring effectively reduces the risk of impairment of neurological function following MIS-TLIF surgery. It is recommended to widely apply neurophysiological monitoring in similar surgeries to enhance neurological protection.